| Medical Information for Mirtel |
Name: Mirtel
Mirtel has been born with high backwardness from inside the womb, strong psycho-social backwardness upon arriving at the
Orphanage (May 2009. Slight mental backwardness was diagnosed at the Tartu Children’s Clinic. Extracts from the
Children’s Clinic have been attached.
A girl at the age of 4 years and 4 months for the evaluation of dynamics. Adapting problems during the examinations. Does
not express herself with words ( does not say her name, age). Does not understand orders. It is not possible to do the Kaufman
test due to her development level. IS able to make difference of colors with her eyes, draws balls of yarn. Tremor in her hands
when doing determined movements with her hands. Her development is appropriate for the age of 2 years and 6 months – 3
years according to the Griffiths tests. Needs constant special pedagogical activities and the evaluation of development once a
year. Needs a consultation with a children’s psychiatrist. F83.0 mixed-type development disorder.
The child has been living at the Orphanage for Young Children since May 2009, parents have been deprived of their
parental rights with an order from the court. The child was scared, clumsy and distrustful towards grown-ups when she
arrived at the orphanage. She adapted with the other children in about a month (there are 10 children in the family at the
age of 3-4 years). She gets used to strange children quickly but is still distrustful towards grown-ups. She wore diapers upon
arriving at the orphanage, needed help for eating, was unable to hold a pencil. After a few months she started going to the
toilet when being directed, wears diapers during night-time (mostly dry in the morning), eats independently, brushes her
teeth. Talks with grown-ups minimally, talks with simple sentences with a teacher that she knows, sentences are
grammatical incorrect, words are understandable. She gets along well with the other children, plays role-games, uses more
speech. Is not interested in studying lessons – does not follow the teachers talk, does not take part in studying, observes fellow
students. Objectively: the child is afraid, is sitting in the teachers lap, observes the surroundings with her eyes. After some
time she gives eye-contact. No verbal contact is achieved, answer to questions by choosing and by nodding or shaking her
head. She reacts to jokes by smiling, when the teacher leaves she shows her sadness with tears. Has a good appetite, is
independently eating all the food. Sleeps at lunch, falls asleep in the evening at about 21:00 without problems, has panic-
attacks every night: the child starts to cry out loud, is yelling, sits up in the bed; will calm down after a teacher has consoled
her for a while; in the morning she does not remember what had happened.
Characterization by speech therapist Maire Ingi: Mirtel has received speech therapy help and special pedagogical help at the
Orphanage for Young Children 2-3 times per week starting from May 2009.Mirtel had adjusting problems when arriving at
the orphanage. Was very shy, did not answer questions. She liked physical closeness a lot. Used sentences containing 3-4
words. Speech was agrammatical, both morphological and syntax agrammatism appeared. Eye-hand cooperation was
disturbed. Mirtel has become more talkative. Her vocabulary has widened but is still under the norm appropriate for her
age. She expresses her wishes, wantings and is able to ask for help if she needs it. The development of psychical problems is
not appropriate for the age norms.
From the life anamnesis:
The orphanage worker does no have data about the previous development of the child. In April 2009 (4 years 4 months) the
child was taken to the Ngo Tartu Ülikooli Kliinikum (Tartu University Clinic) due to a long-term cough, the x-ray picture of
the lung with a norm. finding. Was born on 41st week of pregnancy, birth-weight 2450g, height 45,5 (height backwardness
from inside the womb). A few resorbering hematomas on the legs, a modest old hematoma on the right arm. The child is
restless at the department, speaks a few unclear words. The cough is without dynamics in spite of the treatment. The allergy
doctors do not exclude the possibility of asthma but there is no effect from Ventolin.
Print-out 13.11.2009 10:55 1/3
The clinical blood tests with a norm finding. Mantoux test is negative. Psychologist K. Muug. Adapting problems during the
examination, does not express herself with words (does not say her name, age). Can not understand orders. It is not possible to
do the Kaufman test due to her development level. According to Griffiths tests her development is appropriate for a child at
the age of 2 years 6 months – 3 years.
Summary of the objective find:
Psychical status: with a clear concious, formal contact – when turning to the patient, she does give eye-contact and smiles,
she follows obediently when asked to come along. Emotionally calm, often modestly smiling. The patient keeps to herself. She
needs a little help and guidance when doing her hygiene activities: dressing, washing. Has a good appetite, is able to eat by
herself with a spoon. She fell asleep in the evening without problems, slept all the nights without waking up, so panic-attacks
during sleeping.
Somatic status: height 107,5 cm, weight 17 kg, head-girth 47 cm. Has a pale skin and mucosa, pale tongue without calculus.
A few screeches subclavivularly on the right upon the auscultation of the lungs. Heart work is weak, regular. Abdomen is
soft upon palpation, no pain. No aberrances when it comes to the service of cranial nerves. The tendonperiostalreflexes are
symmetrically evocable. Babinski reflex on both sides +/-.
(13.11.2009) The team meeting at the presence of: Dr. Anu Susi, speech therapist Hele Täär, Margit Lenk, doctor.
The patient has been living at the Orphanage for Young Children since May this year, the problem is little of speech, not
taking part of the studies, crying and panic-attacks during night-time. The psychologist K. Muug has evaluated her at the
children’s clinic, her development is appropriate for a child at the age of 2 y 6m – 3y according to the Griffiths tests.
At the hospital it was possible to have a formal contact with the patient. Follows only simpler orders. It seems that the patient
is unable to for longer sentences and to follow more difficult orders. The patient spends most of her time sitting by herself and
observing the activities of other children. Is searching or physical contact. During being treated at the hospital she slept
calmly, did not wake up and did not have any sleeping panic-attacks.
Her intellectual abilities are lower than appropriate for her age according to the results of psychological tests. PEP-R shows
that the child’s development is appropriate for a child at the age of 1 year and 11 months, the development zone can only
react 2 years and 2 months. Motorical development is also slower than appropriate for her age, is clumsy, has bad eye-hand
cooperation. Social communication is limited, is not able to ask for help or to explain her needs. Is searching for contact with
other children but mostly does not understand the idea of the game and does not interact with the activity. Her behavior is
calm, no irritation or aggressiveness appear. She is not able to stand up for herself when she is being harassed.
Diagnosis: slight mental backwardness without significant behavioral disorder. Inorganic enuresis.
Consultation of a neurologist is needed due to the pathological EEG find.
The repeated study of intellect is needed in one year.
(07.11.2009) EEG examination.
Summary: pathological EEG. Mostly the awake and asleep EEG is according to the norm appropriate for her age. Focal
pathology with epileptic signs and slowing down in the O2 sphere.
The signs are more frequent while asleep. Focal epilepsy. Symptomatic? Cryptogenic?
(12.11.2009) KT-study of the head.
Opinion: finding according to norm.
(12.11.2009) The study of the child behavior, PRUULMANN, KATRIN – M0521 – E95 – psychologist
Based on the previous studies it can be said that her cognitive skills are right now lower than would be appropriate for her
age.
The patient comes on, is a bit shy at first but starts to smile on her own when seeing toys, after a while starts speaking by
whispering. Talks mostly about the names of animals and the sounds they make.
She does the things that have been given for her to do, does not show her own preferences and wishes.
She draws circles when given a paper and a pencil. The circles are in a line and not messed up. Does not try to copy any other
shapes.
She recognizes the examination on the second day of the examinations and smiles from the beginning, no verbal contact.
Her activities consist of placing toy-furniture in lines, also planes and boats. She also takes some toy-animals, places them in
the beds at first but then lines them up with the other toys. She looses interest in about half an hour, she puts the things back
on to the shelf but it is understandable that she can not quite remember where everything goes.
That kind of activity is characteristic to a younger age and thereby indicates the possibility of a backwardness in
development.
EXTRACT from the ambulatory card
Surname and given name: MIRTEL
The patient has been coming to see the children’s psychiatrist at the Psychiatric Clinic of the NGO Tartu University Clinic
since 05.11.2009. The patient was at the children’s department of the Psychiatric Clinic of the NGO Tartu University Clinic
for stationary examinations from 05.11.2009-13.11.2009 with the diagnosis for slight mental backwardness without
significant behavioral disorder F70.0; additional illness: insufficient parental guidance and control Z62.0; additional illness:
non-organic enuresis F98.0.
Last time she came to the ambulatory reception on 01.02.2011 for the evaluation of the level of development because the
patient is to be adopted to the United States of America. The patient has behavioral problems and problems with
communicating with children her age. She is able to serve herself. Patient has been diagnosed with epilepsy, she regularly
uses drugs. She has not had convulsion seizures recently. She needs to be individually attended to and also individual
attention, she needs a longer period of time for getting used to strangers. She does not go to kindergarten at the present time,
a special pedagogue and a speech therapist deal with the child at the orphanage based on an individual program.
A repeated examination for studying the level of development was done on 01.02.2011:
SUMMARY OF THE PSYCHOLOGICAL EXAMINATION OF THE CHILD
Name: Mirtel; Age: 6 years 1 month (73 months); Date of examination: 01.02.2011
Overall characterization – the patient was directed to the examination in order to specify the level of mental development.
Contact with the patient is established fast, the patient is shy at first but becomes more talkative quite fast. Patient has
previously been at the same room (2009) and compared to that time she is more courageous, confident but most likely does
not knowingly recognize the situation herself.
Behavior during the testing situation – the patient starts to act bravely, she is quite constant when it comes to the exercises
that are feasible to her, she gives up fast when it comes to exercises that are harder. If the exercise is interesting for her she
also asks questions (for example: why isn’t there a table in the box if there is a chair in the box etc). She does not complain of
getting tired or bored.
Hand activities – copying and drawing is approximately on the level of child at the age of 4 years, the line is strong and she
holds a pencil on a satisfactory level.
Intellectual activities – the level of the mental activities of the patient has been evaluated at the present examination based
on the Griffiths development scale and the overall result (51 months) is a bit lower than appropriate for hear age and
therewith quite balanced. When it comes to overall motorics the patient is a bit unsure than children her age with balance
exercises and throwing balls. When it comes to personal-social skills she has problems with orientating in her own personal
data – she does not say her surname, age, needs more guidance and support than children her age. Hearing and speech: she
knows colors more or less as appropriate for her age, uses pronouns, sentences are satisfactory but she has problems with
verbal-logical operations and she also does not know all the letters in her name. There are hardships when it comes to picture
vocabulary (for example she mixes up hat and cup, owl and parrot), but that may be somewhat connected to the trait of
character of her growing environment. When it comes to practical realization the patient is quite fast with simpler activities
but she is not able to fulfill harder and constructive exercises as appropriate for her age. The patient knows the meaning of
“bigger , higher, longer” and is able to evaluate these qualities right. She is able to count to six and also is able to repeat 3
number if she is motivated.
Trait of character of behavior and appearances of personality – the patient is mostly joyful, wishes to cooperate but needs a
slow tempo and encouragement.
Conversation with the parent (guardians) – it did not happen at the present examination but according to the decriptions of
the guardians the child may become mutistic when communicating with stangers.
Diagnose:
Slight mental backwardness without sufficient behavioral disorder F70.0;
Ideop. epilepsy connected with paikmed, loc. epileptic seizures. Sündr. G40.0;
Microcephaly, in other words small-headedness Q02
Summary and recommendations – activites with a speech therapist and a special pedagogue are needed, in the conditions of
the kindergarten if possible. It is recommended to observe the development dynamics.
